empagliflozin for treating chronic heart failure with preserved or mildly reduced ejection fraction

Last edited 11/2023 and last reviewed 11/2023

Empagliflozin for treating chronic heart failure with preserved or mildly reduced ejection fraction

In the EMPEROR-Preserved trial (1):

• empagliflozin reduced the combined risk of cardiovascular death or hospitalization for heart failure in patients with heart failure and a preserved ejection fraction, regardless of the presence or absence of diabetes
• noted that "..Treatment with empagliflozin led to a lower incidence of hospitalization for heart failure, but it did not appear to affect the number of deaths from cardiovascular or other causes in the current trial. It is noteworthy that the percentage of patients who discontinued treatment for reasons other than death was 23% overall and was similar in the two treatment groups; this high rate of discontinuation may have driven the effect size toward the null hypothesis.."

NICE state (2):

• empagliflozin is recommended, within its marketing authorisation, as an option for treating symptomatic chronic heart failure with preserved or mildly reduced ejection fraction in adults
• if people with the condition and their clinicians consider empagliflozin to be 1 of a range of suitable treatments (including dapagliflozin), after discussing the advantages and disadvantages of all the options, use the least expensive

NICE committee stated "..evidence from a clinical trial shows that empagliflozin plus standard care reduces the combined risk of dying from cardiovascular causes or likelihood of first hospitalisation for heart failure compared with placebo plus standard care. There is no clinical trial evidence directly comparing empagliflozin with dapagliflozin. The trials for empagliflozin and dapagliflozin have some differences, including the populations included in the trials and how outcomes are defined. When adjustments for these differences are made, an indirect comparison suggests the treatments have similar clinical effectiveness and a similar effect on quality of life.

A cost comparison suggests empagliflozin has similar costs to dapagliflozin. So, empagliflozin is recommended. Empagliflozin should be started on the advice of a heart failure specialist..."

Reference:

1. Anker SD et al. EMPEROR-Preserved: effect of empagliflozin on cardiovascular death and heart failure hospitalisations in patients with heart failure with a preserved ejection fraction, with and without diabetes. NEJM August 27, 2021 DOI: 10.1056/NEJMoa2107038
2. NICE (October 2023). Empagliflozin for treating chronic heart failure with preserved or mildly reduced ejection fraction